Yao Yun-Tai, He Li-Xian, Tan Jie-Chao
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
J Clin Anesth. 2020 Dec;67:110020. doi: 10.1016/j.jclinane.2020.110020. Epub 2020 Sep 1.
Activated clotting time (ACT) is a non-specific test to evaluate the adequacy of systemic heparinization whose value could be influenced by many factors. Tranexamic acid (TXA) is a widely used antifibrinolytic agent worldwide and whether TXA influences ACT value in cardiac surgical patients remains unknown. Current study was performed to address this question.
Systematic review and meta-analysis. PUBMED, Cochrane Library, EMBASE, OVID and Chinese BioMedical Literature & Retrieval System were searched using search terms "tranexamic acid", "activated clotting time", "cardiac surgery", "randomized controlled trial" till May 7th, 2020, to identify all relevant randomized controlled trials (RCTs).
Operating room.
Cardiac surgical patients.
TXA or placebo.
Primary outcomes of interest included peri-operative ACT values. Secondary outcomes of interest include heparin dosage, protamine dosage, postoperative bleeding and blood transfusion.
Search yielded 13 studies including 1168 patients, and 619 patients were allocated into Group TXA and 549 into Group Control (placebo). Meta-analysis suggested that, ACT values after heparinization [(WMD = -1.45; 95%CI: -12.52 to 15.43; P = 0.84)] and after protamine [(WMD = -1.18; 95%CI: -2.81 to 0.46; P = 0.16)] were comparable between Group TXA and Group Control, and that TXA did not influence heparin dose in adult patients [(WMD = 0.38; 95%CI: 0.30 to 0.46; P<0.00001) with no heterogeneity (I = 4%, P = 0.35)] and protamine dose for heparin reversal [(WMD = 5.23; 95%CI: -0.33 to 10.80; P = 0.07) with no heterogeneity (I = 0, P = 0.58)]. Meta-analysis also demonstrated that, TXA administration significantly reduced post-operative bleeding volume [(WMD = -126.33; 95%CI: -177.46 to -75.19; P < 0.0001), post-operative red blood cell (RBC) transfusion volume [(WMD = -71.86; 95% CI: -88.22 to -55.50; P < 0.00001), fresh frozen plasma (FFP) transfusion volume [(WMD = -13.83; 95% CI: -23.67 to -4.00; P = 0.006) and platelet concentrate (PC) transfusion volume [(WMD = -0.20; 95% CI: -0.29 to -0.10; P < 0.0001).
This meta-analysis suggested that, TXA administration did not influence ACT value, heparin and protamine doses, but significantly reduced post-operative blood loss and transfusion requirement in cardiac surgical patients.
活化凝血时间（ACT）是一项用于评估全身肝素化是否充分的非特异性检测，其数值可能受多种因素影响。氨甲环酸（TXA）是一种在全球广泛使用的抗纤溶药物，TXA是否会影响心脏手术患者的ACT值尚不清楚。本研究旨在解决这一问题。
系统评价和荟萃分析。使用检索词“氨甲环酸”“活化凝血时间”“心脏手术”“随机对照试验”在PUBMED、Cochrane图书馆、EMBASE、OVID和中国生物医学文献数据库中进行检索，截至2020年5月7日，以识别所有相关的随机对照试验（RCT）。
手术室。
心脏手术患者。
TXA或安慰剂。
主要关注的结局包括围手术期ACT值。次要关注的结局包括肝素剂量、鱼精蛋白剂量、术后出血和输血情况。
检索得到13项研究，共1168例患者，其中619例患者被分配到TXA组，549例患者被分配到对照组（安慰剂组）。荟萃分析表明，TXA组和对照组在肝素化后[加权均数差（WMD）=-1.45；95%置信区间（CI）：-12.52至15.43；P=0.84]和使用鱼精蛋白后[WMD=-1.18；95%CI：-2.81至0.46；P=0.16]的ACT值相当，且TXA不影响成年患者的肝素剂量[WMD=0.38；95%CI：0.30至0.46；P<0.00001，无异质性（I²=4%，P=0.35）]以及用于中和肝素的鱼精蛋白剂量[WMD=5.23；95%CI：-0.33至10.80；P=0.07，无异质性（I²=0，P=0.58）]。荟萃分析还表明，给予TXA可显著减少术后出血量[WMD=-126.33；95%CI：-177.46至-75.19；P<0.0001]、术后红细胞（RBC）输血量[WMD=-71.86；95%CI：-88.22至-55.50；P<0.00001]、新鲜冰冻血浆（FFP）输血量[WMD=-13.83；95%CI：-23.67至-4.00；P=0.006]和血小板浓缩液（PC）输血量[WMD=-0.20；95%CI：-0.29至-0.10；P<0.0001]。
这项荟萃分析表明，给予TXA不影响ACT值、肝素和鱼精蛋白剂量，但可显著减少心脏手术患者的术后失血量和输血需求。
